When is the right time to have your child fitted with braces?

By Dr. ArgiroKechagia, BDS, MFDS (rcsed), MSc

It is frequently difficult for parents to realize when their child needs orthodontic treatment since there are often malocclusions where the front teeth appear straight. In general, the orthodontic treatment takes place between 9-14 years old, when most or all of the primary teeth have been shed.

However, around the age of 7-8, the child has enough permanent teeth in order for the orthodontist to diagnose if there will be future malocclusion. The orthodontic examination at an early age can be very important, since in many circumstances the early diagnosis and prevention makes the future treatment easier for the patient and the doctor. This does not mean that all children need treatment at this age, but it does allow the orthodontist to determine whether your child could benefit from early intervention. 

More specifically, early orthodontic treatment can help avoid extraction of permanent teeth and better control of skeletal problems since the orthodontist can influence the skeletal growth if the patient is still growing.

After a very detailed examination of the face, the jaws and the teeth as well as an assessment of x-rays, photographs and molds of teeth, the orthodontist will assess whether the child or teenager requires treatment and will be able to formulate a suitable treatment plan.

There are different kinds of appliances that can be used depending on the patient’s situation. The most frequent appliances are:

·         Fixed Braces

Fixed braces are the appliances that cannot be removed during the treatment. These are the most common type of orthodontic brace. Most patients require the use of fixed orthodontic appliances (‘train tracks’) to have really straight teeth, and achieve the best possible improvement of their smile. They are placed in the upper and lower jaw, for arch expansion, movement of teeth or anchorage control. Sometimes rings called bands are also fitted around the back/molar teeth.  The orthodontist adjusts the fixed braces every 4-6 weeks.

·         Removable braces

Sometimes fixed braces are not the ideal appliances to bring about the required changes to the bite, and a removable brace has to be used. A removable brace simply clips onto the teeth, and can be easily fitted or removed. Its insertion or removal does not cause any pain. They are most commonly used in order to change the shape of the dental arch (i.e. expansion) as well as promote or modify growth of the jaws, adapt the soft tissues and muscles of the face to new positions, move whole groups of teeth at the same time or change the angulation of teeth. These appliances are used in pre-adolescence and adolescence age.

One other advantage of these appliances is that it can be removed when patients want to eat and brush their teeth. The major challenge is that their result depends on patient’s compliance.

·         Headgears

Headgears are being used less and less by orthodontists these days; but its use is still necessary in a small minority of cases. It is supported by the neck or the head of the patient and is worn to move the back teeth further back in order to create extra space; or to stop the back teeth from moving forwards and keep them in their present position, whilst the front teeth are being straightened. Headgear also helps you achieve the best possible bite between your upper and lower teeth.

Active treatment time with orthodontic braces typically ranges from six months to two years, but there is always some variability depending on the case. More particularly, the duration of treatment depends on the growth of the patient’s mouth and face, the individual’s biological response to the brace, the severity of the problem and the cooperation of the patient.

While orthodontic treatment requires some commitment, patients are rewarded with healthy straight teeth, proper jaw alignment and a beautiful smile that lasts a lifetime. Untreated orthodontic problems may contribute to tooth decay, diseased gums, temporomandibular joint problems and loss of teeth. Protruding teeth are more susceptible to accidental chipping and other forms of dental injury. Crooked teeth can also lead to a decrease in one’s self-confidence. Sometimes, the increased cost of dental care resulting from untreated malocclusion (bad bite) far exceeds the cost of orthodontic care.

It has been proven that improvements in personal appearance contribute to greater mental and physical well-being. Although treatment may sometimes seem lengthy, creating a beautiful smile is a reliable way of improving the health of your teeth as well as your self-esteem. In this way, orthodontic treatment can benefit social and career success, as well as improve one’s general attitude towards life.

What Is Oral Cancer And Are You at Risk?

April is Oral Cancer Awareness Month.

Regular dental checkup is the first line of defense in early detection of oral cancer.

According to the World Health Organization (WHO), oral cancer ranks eighth among the most common cancer worldwide. Globally, more than 300,000 new cases of lip and oral cavity cancer were estimated to have been diagnosed in 2012.

In the United States, oral and pharyngeal cancer (cancer of the mouth and upper throat) collectively kills nearly one person every hour.

In the Middle East, a multicenter, retrospective study on oral cancer finds that the death rate due to oral cancer in the Middle East is reported to be approximately 2 in 100,000.

Dr. Marwan Al-Obeidi, Clinical Head at Dr. Michael’s Dental Clinics talks about the disease and the role of dentists in its early detection.

What is oral cancer?

Oral Cancers are a part of a group of cancers commonly referred to as head and neck cancers. Oral cancer can affect any part of the oral cavity, particularly the tongue, floor of the mouth, the cheeks, bones, and lips. It is among the most prevalent cancers in the world and its incidence is increasing every year. The prevalence of this cancer is higher in males than females.

What are the causes of oral cancer?

There appears to be a direct link between oral cancer and well-defined predisposing factors. These factors are mainly tobacco smoking and smokeless tobacco (chewing) and alcohol. In fact, the WHO reports that tobacco use (smoking or chewing) and excessive alcohol consumption account for an estimated 90% of oral cancers worldwide.

Exposure of the lip to direct sunlight also accounts for a very high rate of lip cancers in countries with a population exposed to high amounts of direct sunlight such as Australia and indeed the Middle East.

Other risk factors include genetics and a certain group of viruses known as HPV (Human papillomavirus).

What is the role of dentists in oral cancer detection?

Our role as dentists is vital in early detection of oral cancers as early detection has been proven to dramatically increase the chances of successful treatment and survival rates for patients. We are also working very hard as a group of professionals to educate the population on the risks of predisposing factors and trying to raise awareness about this ever growing threat to our health.

It is very important that our patients are aware of any predisposing factors that can affect their health and we are continually trying to reduce the exposure to these factors.

Alongside health promotion, we also have a duty to carefully examine the whole oral cavity during each checkup appointment. As dentists, we are uniquely placed in a privileged position to be able to see most of our patients every 6 months for routine dental examinations. It is at these examinations that a general oral cancer screen is carried out where not only do we discuss any predisposing factors but we also actively screen for any abnormal lesions in the mouth.

How is oral cancer detection done during dental checkups?

As part of your routine dental exam, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue as well as check for any signs and symptoms mentioned above.

Your dentist may perform a biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue, and analyzing it for abnormal cells. Alternatively, if the tissue looks more suspicious, your dentist may recommend a referral to a more experienced specialist colleague who will carry out further tests if necessary. These tests are vital to detect oral cancer early, before it has had a chance to progress and spread.

What are the warning signs of oral cancer?

Oral cancer can present itself in many ways and is usually pain free at the early stages. It can present as simple swellings or lumps or even a patch on the oral mucosa (soft tissues) which can appear as just a redness or even a simple ulcer which doesn't heal. Other signs to look out for are a change in the hoarseness of the voice or difficulty in swallowing and movement of the tongue can be found to be constricted. All of the above can usually be accompanied by a dramatic decrease in weight over a relatively short period of time.

Importance of regular dental visits

It is very important to regularly visit your dentist even if you are not experiencing any symptoms as oral cancer often remains pain-free for several months and the patient is usually unaware of any abnormalities.

On your appointment, you should inform your dentist of all habits that could be predisposing to cancerous lesions such as tobacco use and alcohol consumption and any other medical conditions you may have. It is also important to inform your patient of any family history of cancer. The dentist will give you advice regarding these factors before carrying out a detailed examination of your oral cavity to ensure that no lesions or abnormalities are seen.

Remember, early detection is critical for successful treatment so if you haven't seen your dentist for a while, book a checkup appointment now and make sure that not only your teeth are healthy but your whole mouth is disease free!

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Early Childhood Caries: A Major Health Concern

By: Dr.Carol Onyango DMD, MPH

1.        What is Early Childhood Caries (ECC)?

Dental caries is a chronic infectious disease caused by bacteria that breaks down sugar into acids which erode teeth over time. 

If a child under the age of six years old has at least one cavity, missing tooth due to dental caries or a filling on any baby tooth, then they are considered to have early childhood caries. 

If they are younger than three years old, and have a cavity on any tooth surface, then this is severe early childhood caries.

2.      What are the risk factors of early childhood caries?

Apart from poor oral hygiene, there are several risk factors that increase chances of getting ECC.  Young children are at risk of early childhood caries if their caregiver has high levels of the bacteria causing decay.  The disease can be transferred to the child through saliva for instance, when sharing utensils or cleaning a pacifier with the mouth. 

Other risk factors include a high consumption of sugar particularly between meals.  The most obvious foods that cause decay are chocolates, sweets, cookies, juice, sodas and so on.  However, sticky sweet foods such as raisins, dates and some dried fruit also increase the risk of tooth decay.  Some medicines given to children are flavoured with high amounts of sugar and this too may increase the risk of early childhood caries. 

Putting sweet drinks in sippy cups and milk bottles and/or allowing children to go to sleep with milk in a bottle increases the risk of developing ECC as well.

3.      What are the consequences of ECC?

The health of children’s teeth should not be minimised just because they are “baby teeth.”  When children have ECC, the resulting pain and infection can cause several major problems.  Most children are not very good at describing pain and parents may become aware of the severity only as a result of restless nights or poor sleep, poor eating habits and lack of concentration in school; all of which are very important for proper growth and development of the child. 

In addition, if ECC is left untreated for a while, the infection can become serious leading to high fever, admission into the hospital, emergency room visits and a much higher cost of treatment.  Children who have ECC are also more likely to develop caries in their permanent teeth if changes are not made early on.

4.      How can ECC be prevented?

a)      Mothers should make sure that they have a dental check-up and complete any necessary treatment to avoid passing on decay-causing bacteria to their children.

b)      Parents should also minimise saliva sharing activities such as cleaning pacifiers with the mouth and sharing utensils.

c)       Parents should bring their children to visit a paediatric dentist by age one to establish a dental home for their child.

d)      Oral hygiene is very important.  Parents should brush their children’s teeth at least twice daily with an age-appropriate toothbrush and fluoride toothpaste.  For children under age 3, a smear amount of fluoride toothpaste is sufficient while a pea-size amount should be used for children between 3 and 8 years old.

e)      Children at risk of getting early childhood caries should visit their paediatric dentist for professionally applied fluoride.

f)        Minimising consumption of sugar overall and also sweet snacks and drinks between meals.

g)      Minimising the consumption of processed foods that have high amounts of hidden sugars will also prevent tooth decay.

h)      Prevent putting children to bed with milk in a bottle and/or wipe teeth with a wet cloth after night-time milk feeding.

i)        Avoid putting juices and other sweet drinks in baby bottles and sippy cups.

j)        As children approach their first birthday, they should be encouraged to drink from a regular cup.

The Truth About Hollywood Smiles

American dentist in Dubai and Digital Smile Design expert Dr. David Donelson talks about Hollywood Smiles – the truth, the fads and the cost.

Patients beware, not all “Hollywood” smiles are created equal. I can’t count how many times I see real celebrities or “insta-celebrities” with hundreds of thousands of followers on Instagram advertising about their newly-acquired Hollywood smile.

The notion of a “Hollywood” smile has been largely created by media outlets over the past several decades. Many celebrities grace the covers of magazines like US Weekly, People, and The Enquirer after cosmetic procedures performed for their red carpet events. Smile makeovers are quite common among these cosmetic procedures loved by the Hollywood elite.

Dr. David Donelson, DMD, FAGD

A once unnoticeable or crooked smile of your favorite celebrity now has sparkling white symmetrical teeth. If this is the standard for what you are looking for then be prepared to spend big dollars to have your smile curated by a top clinician. Smiles can range anywhere from 40k-150k dirhams.

As with most things in life, you pay for what you get. Don’t be fooled by offers for insanely cheap veneers or “Hollywood Smiles”. The best smile in the world is truly at the hands of a great dental technician who creates the teeth. The work of master ceramists cost much than that of an average ceramist. Therefore the overall cost for the teeth is much more depending on who your dentist is uses to make the teeth.

Do good homework and find an esthetic dentist who has a portfolio of his work. Ask lots of questions and don’t hesitate to get a second opinion. This will drastically increase your chances of obtaining that perfect “Hollywood Smile”.

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To book your Digital Smile Design consultation with Dr. David Donelson, please call Dr. Michael’s Dental Clinic in Jumeirah at 04-3495900 today or book an appointment online.